scholarly journals The Potential for Arrhythmia during Central Venous Catheter Insertion- to where does the guidewire migrate?

2021 ◽  
Author(s):  
Daphna Reichmann ◽  
Re'em Sadeh ◽  
Ori Galante ◽  
Yaniv Almog ◽  
Victor Novack ◽  
...  
Keyword(s):  
Intensive Care ◽  
Right Ventricle ◽  
Real Time ◽  
Right Atrium ◽  
Medical Center ◽  
Insertion Site ◽  
Vena Cava ◽  
Venous Catheter ◽  
Seldinger Technique ◽  
The Right

Abstract BackgroundCentral Venous Catheters (CVC) are being used in both intensive care units and general wards for multiple purposes. A previous study1 observed that during CVC insertion through Subclavian Vein (SCV) or the Internal Jugular Vein (IJV) the guidewire is sometimes advanced to the Inferior Vena Cava (IVC), and at other times to the right atrium. The rate of IVC wire cannulation and the association with side and point of insertion is unknown.ObjectiveIn this study, we describe guidewire migration location during real time CVC cannulation (right atrium versus IVC) and report the association between the insertion site and side of the CVC and the location of guidewire migration, Right Atrium (RA)/Right Ventricle (RV) versus IVC guidewire migration.DesignThis is a retrospective study of the prospectively and systematically collected data on CVC insertion under real time trans thoracic ultrasound.SettingThe medical Intensive Care Unit in Soroka Medical Center, among patients that have received CVC during the study years 2014–2020.Main outcome measures:The rate of IVC versus right atrium/right ventricle wire migration during the procedure were analyzed. The association between the side and point of CVC insertion and the wire migration site was analyzed as well.ResultsOne hundred and sixty-six patients were enrolled. 33.7% of wires migrated to the IVC and 66.3% to the versus right atrium/right ventricle. The rate of wire migration to the IVC was similar in the IJV site and the SCV site. There was no association between the side of CVC insertion and wire migration to the IVC.ConclusionAbout a third of all wire migrations, during CVC Seldinger technique insertion, were identified in the IVC, with no potential for wire associated arrhythmia. There was no association between CVC insertion point (SCV versus IJV) nor the side of insertion and the site of guidewire migration.

scholarly journals Central venous catheter insertion- guidewire migration ratio: Right heart to inferior vena cava

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0252726
Author(s):  
Daphna Reichmann-Ariel ◽  
Re’em Sadeh ◽  
Ori Galante ◽  
Yaniv Almog ◽  
Lior Fuchs
Keyword(s):  
Intensive Care ◽  
Inferior Vena Cava ◽  
Right Ventricle ◽  
Right Atrium ◽  
Inferior Vena ◽  
Insertion Site ◽  
Vena Cava ◽  
Venous Catheter ◽  
Seldinger Technique ◽  
Central Venous

Background Central Venous Catheters (CVC) are being used in both intensive care units and general wards for multiple purposes. A previous study Galante et al. (2017) observed that during CVC insertion through Subclavian Vein (SCV) or the Internal Jugular Vein (IJV) the guidewire is sometimes advanced to the Inferior Vena Cava (IVC), and at other times to the right atrium. The rate of IVC wire cannulation and the association with side and point of insertion is unknown. Objective In this study, we describe guidewire migration location during real time CVC cannulation (right atrium versus IVC) and report the association between the insertion site and side of the CVC and the location of guidewire migration, Right Atrium (RA)/Right Ventricle (RV) versus IVC guidewire migration. Methods This is a retrospective study in the medical intensive care unit among patients that have received CVC during the study years 2014–2020. The rate of IVC versus right atrium/right ventricle wire migration during the procedure were analyzed. The association between the side and point of CVC insertion and the wire migration site was analyzed as well. Results One hundred and sixty-six patients were enrolled. 33.7% of wires migrated to the IVC and 66.3% to the versus right atrium/right ventricle. The rate of wire migration to the IVC was similar in the IJV site and the SCV site. There was no association between the side of CVC insertion and wire migration to the IVC. Conclusion About a third of all wire migrations, during CVC Seldinger technique insertion, were identified in the IVC, with no potential for wire associated arrhythmia. There was no association between CVC insertion point (SCV versus IJV) nor the side of insertion and the site of guidewire migration.

scholarly journals Risk Factors for Intracardiac Thrombosis in the Right Atrium and Superior Vena Cava in Critically Ill Neonates who Required the Installation of a Central Venous Catheter

2016 ◽  
Vol 57 (4) ◽  
pp. 288-294 ◽  
Author(s):  
Alfredo Ulloa-Ricardez ◽  
Lizett Romero-Espinoza ◽  
María de Jesús Estrada-Loza ◽  
Héctor Jaime González-Cabello ◽  
Juan Carlos Núñez-Enríquez
Keyword(s):  
Risk Factors ◽  
Central Venous Catheter ◽  
Right Atrium ◽  
Superior Vena ◽  
Vena Cava ◽  
Venous Catheter ◽  
Central Venous ◽  
Critically Ill Neonates ◽  
The Right ◽  
Intracardiac Thrombosis

CARDIAC ARREST DURING STRENUOUS EXERCISE IN A PATIENT WITH CONGENITAL HEART DISEASE

PEDIATRICS ◽  
1963 ◽  
Vol 32 (4) ◽  
pp. 776-777
Author(s):  
Albert A. Kattus
Keyword(s):  
Heart Disease ◽  
Medical Student ◽  
Pulmonary Artery ◽  
Right Ventricle ◽  
Right Atrium ◽  
Vena Cava ◽  
Systolic Pressure ◽  
Strenuous Exercise ◽  
Heart Catheterization ◽  
The Right

THE FOLLOWING CASE is presented in order to introduce a note of caution into consideration of the advisability of recommending unmonitored exercise for patients with heart disease. The patient is a 24 year old third year medical student who had been known to have a heart murmur since birth. He had lived a vigorously active life and had participated in high school football as well as snow skiing in more recent years. At the age of 19 he underwent a detailed cardiac work-up including right heart catheterization at another hospital. The findings at that time included a normal examination except for a grade III/VI blowing pansystolic murmur at the 4th left intercostal space. The chest x-ray disclosed a normal cardiac silhouette with normal pulmonary vascularity. The electrocardiogram disclosed right bundle branch block and left axis deviation. Cardiac catheterization disclosed systolic pressure of 30 mm. Hg. in the right ventricle and 23 in the pulmonary artery. There was O2 saturation of 78 per cent in the superior vena cava and 75 per cent in the inferior vena cava. In the high and mid right atrium O2 saturations ranged from 76 per cent to 80 per cent. Low in the atrium, just above the tricuspid valve, there was a small step-up of O2 saturation to 83 per cent and similar saturations were found in the right ventricle and pulmonary artery. The findings suggested a small shunt from left ventricle to right atrium of the type seen in the transitional form of atrio-ventricular communis. During the two weeks prior to the present event the patient and his roommate who was also a third year medical student, had undertaken to improve their physical conditioning by performing the Canadian Air Force series of calisthenic exercises.

Accurate placement of the distal end of a ventriculoatrial shunt with the aid of real-time transesophageal echocardiography

2006 ◽  
Vol 105 (1) ◽  
pp. 153-156 ◽  
Author(s):  
Theofilos G. Machinis ◽  
Kostas N. Fountas ◽  
John Hudson ◽  
Joe Sam Robinson ◽  
E. Christopher Troup
Keyword(s):  
Transesophageal Echocardiography ◽  
Real Time ◽  
Superior Vena Cava ◽  
Right Atrium ◽  
Jugular Vein ◽  
Superior Vena ◽  
Vena Cava ◽  
Distal Catheter ◽  
The Mean ◽  
The Right

Objective Ventriculoatrial (VA) shunts remain a valid option for the treatment of hydrocephalus, especially in patients in whom ventriculoperitoneal (VP) shunts fail. Correct positioning of the distal end of the catheter in the right atrium is of paramount importance for maintaining shunt patency and reducing the incidence of VA shunt-associated morbidity. The authors present their experience with real-time transesophageal echocardiography (TEE) monitoring for the accurate placement of the distal catheter of a VA shunt. Methods Four patients underwent conversion of a VP shunt to a VA shunt under the guidance of intraoperative fluoroscopy and TEE between May 2003 and December 2004. After induction of general anesthesia, the TEE transducer was advanced into the esophagus. A cervical incision was made and the external jugular vein was visualized. An introducer was passed through an opening in the jugular vein and a guidewire was placed through the introducer. Under continuous TEE guidance, the guidewire was carefully advanced into the superior vena cava. A distal shunt catheter overlying a J-wire was then passed to the superior vena cava, again under TEE guidance. The catheter was advanced to the right atrium after removing the guidewire. Final visualization with TEE and fluoroscopy revealed a good position of the catheter in the right atrium in all four cases. The mean duration of the operation was 91 minutes (range 65–120 minutes) and the mean operative blood loss was 23 ml (range 10–50 ml). No procedure-related complication was noted. Conclusions Real-time TEE is a safe and simple technique for the accurate placement of the distal catheter of a VA shunt.

scholarly journals Percutaneous Embolectomy of Serpentine Thrombus from the Right Atrium in a 51-Year-Old Man

2016 ◽  
Vol 43 (6) ◽  
pp. 524-527 ◽  
Author(s):  
Soumya Patnaik ◽  
Harish Seetha Rammohan ◽  
Mahek Shah ◽  
Shivani Garg ◽  
Vincent Figueredo ◽  
...  
Keyword(s):  
Inferior Vena Cava ◽  
Right Ventricle ◽  
Right Atrium ◽  
Inferior Vena ◽  
Vascular System ◽  
Vena Cava ◽  
Pump System ◽  
Surgical Risk ◽  
Aspiration System ◽  
The Right

Treatment of large, fresh thrombi in the vascular system can be challenging. AngioVac, a cardiopulmonary pump system, has been used to remove large thrombi and even some tumors by a percutaneous route. We report here a case of a 51-year-old man who presented with a large thrombus (7.5 × 1.5 cm) in his inferior vena cava, extending into his right atrium and right ventricle. Because the surgical risk was high, we attempted percutaneous embolectomy via the AngioVac aspiration system. We also review the literature concerning this emerging technique.

scholarly journals P1451 Massive fatal venous thrombosis

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
M M De La Torre Carpente ◽  
B Redondo Bermejo ◽  
T M Perez Sanz ◽  
M A Acuna Lorenzo ◽  
M I Revilla Martinez ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Lower Extremity ◽  
Right Ventricle ◽  
Right Atrium ◽  
Vena Cava ◽  
Iliac Vein ◽  
Common Iliac Vein ◽  
Increased Risk ◽  
The Right ◽  
In Transit

Abstract We present the case of a 63-year old woman with previous history of high-grade liposarcoma. of the lower extremity. She had been treated with radiotherapy and chemotherapy and then she underwent surgical treatment with wide local excision several months ago. She was awaiting a new surgical procedure to remove a right suprarrenal metastasis. The patient presented with lower extremity edema and abdomen and increasing weight in the previuos week. A thoracic and abdominal CT showed the suprarrenal mass had become of greater size. Enlargement of superior vena cava, partial filling defects in several segments of the right lung suggestive of acute pulmonary embolism. Extensive thrombosis from right iliac vein, common iliac vein, intrahepatic cava vein, inferior vena cava, right atrium and right ventricle. Bilateral pleural effusion and ascites. A transthoracic echocardiogram revealed a big mass (6.1 cm) in the right atrium prolapsing into the right ventricle. There was a mean diastolic gradient of 3 mmHg and maximal gradient of 6 mmHg in the tricuspid valve. Left ventricle systolic function was moderately depressed due to abnormal movement of the interventricular septum suggestive of pulmonary hypertension. The clinical course was characterized by rapid deterioration and the patient died from cardiogenic shock. The source of thrombi in the right side of the heart most of the times is venous thrombi that have embolized. Cancer patients have an increased risk of venous thromboembolism compared with the general population. The risk varies depending on the type and the stage of the cancer. Metastatic disease has the highest risk. Most clinically significant pulmonary embolisms originate as venous thromboembolism in the lower extremities or pelvic veins. However in most of the cases it is difficult to image the thrombus "in-transit". In this case the most striking feature is not imaging the thrombus "in-transit" but its massive size. Abstract P1451 Figure. liposarcoma Euro Echo 2019

scholarly journals P718 Unexpected finding during follow up for a suspected arrythmogenic right ventricular cardiomyopathy (ARVC)

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
M Castellanos Alcalde ◽  
N Garcia Ibarrondo ◽  
G Ramirez-Escudero ◽  
R Candina Urizar ◽  
A Lanbarri Izaguirre ◽  
...  
Keyword(s):  
Inferior Vena Cava ◽  
Right Ventricle ◽  
Right Ventricular ◽  
Right Atrium ◽  
Septal Defect ◽  
Inferior Vena ◽  
Vena Cava ◽  
Interatrial Communication ◽  
The Right

Abstract Interatrial communication is the most common congenital defect found in adulthood, being the most common ostium secundum variety (70-80%). Superior and inferior sinus venosus defects are less usual, found in the 5-10% of cases of interatrial communication and frequently associated with anomalous pulmonary venous return (APVR). These defects are located near the junction of the superior (5%) or inferior (<1%) vena cava with the right atrium, which makes them difficult to diagnose by transthoracic ecocardiography (TTE). Case description: A 44-year-old man who is being followed up in our electrophysiology consulting with suspicion of ARVC (suggestive CMR with no gene found) after an episode of ventricular tachycardia (VT) 11 years ago. Asymptomatic since then under treatment with atenolol, except for an episode of chest pain that required a coronary computed tomography which described an image compatible with a patent foramen ovale and normal coronary arteries. During the follow-up a cardio magnetic resonance (CMR) is performed which showed a severely dilated right ventricle with diskinetic areas, no volume changes since last CMR (5 years ago) and preserved ejection fraction. A small interatrial communication located infero-posteriorly in the septum drawed our attention. Estimated QP/QS was 1.4. After this finding, we reviewed the CT made 4 years ago, where a flow from the left atrium to the right atrium could be seen. We decided to ask for both a transthoracic echocardiography (TTE) and a transesophageal echocardiography (TEE). TTE showed normal left ventricle, a dilated right ventricle with preserved function, no valvulopathies and normal pulmonary pressure. Shunt test with agitated saline was slightly positive after Valsalva maneuver, and QP/QS was again 1.4. TTE showed a small interatrial communication measuring 1.9x0.8cm, next to inferior vena cava`s drainage. Since right ventricle dilation could be due both to the atrial septal defect (ASD) and to the dysplasia, the case was discussed in the heart team, and as the defect was small, QP/QS was 1.4 and pulmonary pressure was normal we adopted a conservative approach. Inferior sinus venosus defects are one of the least common atrial septal defects. They are located in the atrial septum immediately above the orifice of the inferior vena cava and are often associated with partial anomalous connection of the right pulmonary veins. This location makes it difficult to see by means of a common TTE or TEE, and usually as in our case multimodal approach can be very helpful. Usually patients with this kind of atrial septal defect (ASD), signs of significant shunt (right ventricular volume overload, QP/QS≥1.5) and systolic PA pressure less than 50% of systemic pressure (with pulmonary vascular resistance less than one third of the systemic vascular resistance) are suggested for surgery. In this case the possibility of two pathologies overlapping makes it challenging for diagnosis and treatment. Abstract P718 Figure. Multimodal imaging for diagnosis.

Abstract 14803: Use of Real-Time Transesophageal Echocardiography to Improve Safety of Lead Extraction

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Brett Oestreich ◽  
Bryan Ahlgren ◽  
Christine Tompkins ◽  
Paul Varosy ◽  
Tamas Seres ◽  
...  
Keyword(s):  
Right Ventricle ◽  
Transesophageal Echocardiography ◽  
Real Time ◽  
Right Atrium ◽  
Premature Termination ◽  
Average Length ◽  
Vena Cava ◽  
Lead Extraction ◽  
Lead Removal ◽  
Severe Hypotension

Background: Transvenous lead extraction (TLE) carries a small but measurable risk of serious adverse events. Few studies have examined the potential benefit of continuous monitoring with transesophageal echocardiography (TEE) during this procedure. Objective: Evaluate the utility of TEE during TLE involving both conventional and laser lead removal. Methods: TEE was performed in 100 consecutive patients undergoing TLE. All patients underwent TLE in the operating room with general anesthesia and continuous TEE monitoring. TLE was attempted for 193 leads in 100 patients. Eighty patients required laser lead extraction (80%). Indications for extraction were device endocarditis (28), lead fracture (28), recalled lead (21), pocket infection (17), and other (6). Results: Sixty-seven patients were male and the average age was 56.96 +- 17.01 years. The average length since lead implant was 78±55.19 (1.4-274.43) months. Complete success occurred in 181 leads (94%), partial success in 4 leads (2%), and failure in 8 leads (4%). Major complications included right ventricle laceration (1) and right atrium/superior vena cava laceration (2) which resulted in detection and localization within 1-2 minutes and prompt surgical repair. Premature termination and unnecessary surgery were prevented in 4 patients with hypotension but no intracardiac abnormalities seen on TEE (Figure 1). There was one upper gastrointestinal bleed from the TEE probe (1). In-hospital mortality was 0%. Conclusion: In total the clinical management was changed in 7 patients (7%) based on real-time TEE monitoring helping to decrease the TLE related mortality and premature termination of the procedure. Figure 1 Monitoring with real time TEE prevented premature termination of cases with severe hypotension showing RV obstruction due to invagination of the free wall. RA: right atrium; RV: right ventricle.

scholarly journals Giant mass but small symptoms; huge thrombosis in the right atrium originating from the superior vena cava and protruding to the right ventricle: a case report

2019 ◽  
Vol 13 (1) ◽  
Author(s):  
Elnaz Javanshir ◽  
Seyyed-Reza Sadat-Ebrahimi ◽  
Rezayat Parvizi ◽  
Mehrnoosh Toufan ◽  
Hosein Sate
Keyword(s):  
Risk Factors ◽  
Right Ventricle ◽  
Superior Vena Cava ◽  
Right Atrium ◽  
Superior Vena ◽  
Vena Cava ◽  
Right Atrial ◽  
Indwelling Catheters ◽  
Laboratory Test Results ◽  
The Right

Abstract Background Thrombosis of the superior vena cava with propagation to the right heart chambers can be seen in the presence of chronic indwelling catheters. Moreover, the idiopathic right atrial thrombi may become entrapped in Chiari’s networks, and idiopathic thrombosis of the superior vena cava may occur rarely because of the underlying coagulation disorders or malignancies. Case presentation A 43-year-old Iranian (Persian) woman was admitted to our hospital with palpitation of 2 years’ duration and mild to moderate dyspnea of 10 days’ duration. Her past medical history, basic laboratory test results, and cardiac enzyme measurements were unremarkable. Imaging studies revealed a 1.4-cm × 7.4-cm multilobulated, hypermobile mass in the right atrium, extending into the right ventricle, that appeared to be emanating from the superior vena cava. Moreover, partial filling defects were visible in the distal parts of both right and left pulmonary arteries extending to their branches, suggesting massive pulmonary emboli. The patient’s huge mass and emboli were removed by surgery, and pathologic evaluations confirmed that all of the specimens were thrombosis. A number of mutations known as risk factors of thrombosis were detected during genetic evaluations. However, mild symptoms of the patient along with a huge mass in the right atrium, thrombosis in the superior vena cava, and massive thromboembolism remained unexplained. Conclusion Huge and dangerous thrombosis inside the heart and superior vena cava can evolve without expected considerable symptoms. Also, detecting the underlying causes of these thromboses sometimes is not feasible by only checking the prevalent known risk factors. Therefore, comprehensive evaluations should be carried out in these patients.

Sign in / Sign up

Export Citation Format

Share Document